AccountId: 011433970860
ContactId: a0ccd284-9fb7-4d84-beff-9b3782dfffce
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 248050 ms
Total Talk Time (AGENT): 77530 ms
Total Talk Time (CUSTOMER): 68204 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/a0ccd284-9fb7-4d84-beff-9b3782dfffce_20250107T13:58_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. This is [PII] calling from provide our office checking on a claim.
[AGENT][NEUTRAL] OK, you said your name is [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I can assist you, [PII]. What's the policy number?
[CUSTOMER][NEUTRAL] Sure. Before that, I would like to inform you that this call is being recorded for quality and training purpose. Policy ID starts with 01769883.
[AGENT][NEUTRAL] Your phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, thanks for that information, [PII] and you said you're checking claim status?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And what is the date of service and the total bill?
[CUSTOMER][NEUTRAL] Uh, the date of service is [PII].
[CUSTOMER][NEUTRAL] Total bill amount is $375.
[AGENT][POSITIVE] Thank you.
[AGENT][NEGATIVE] So, it says that the policy provides no benefits for the treatment of conditions other than a sickness or an injury as defined by this policy. Uh, therefore, no payment was made on this claim. I do show that it was received.
[AGENT][NEUTRAL] [PII] process [PII].
[AGENT][NEUTRAL] And I have the claim number if you would like that that information.
[CUSTOMER][NEUTRAL] Yes, help me with the claim number.
[AGENT][NEUTRAL] 354.
[AGENT][NEUTRAL] 2095.
[AGENT][NEUTRAL] And the claim status can also be um.
[AGENT][NEUTRAL] Checked on our online service center at [PII].
[CUSTOMER][NEUTRAL] Yeah, but, uh, the portal required claim number to to search the claim.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, what is the denial you said?
[AGENT][NEUTRAL] OK. Was the the claim for an accident or a sickness?
[CUSTOMER][NEUTRAL] Sorry, please repeat.
[AGENT][NEUTRAL] What was the reason for the claim? Is it accident? Is it a sickness? Is it wellness?
[CUSTOMER][NEUTRAL] Uh, it's for.
[CUSTOMER][NEUTRAL] Uh, it's a screening code.
[AGENT][NEUTRAL] OK. So what screenings wellness is not covered under the policy.
[CUSTOMER][NEUTRAL] Can you help me with the plan name?
[AGENT][NEUTRAL] The supplemental gap policy.
[AGENT][NEUTRAL] Or Medlink policy.
[CUSTOMER][NEUTRAL] OK, sure, no worries, just help me with the call reference number.
[AGENT][NEUTRAL] My name in today's date.
[CUSTOMER][NEUTRAL] Uh, it's [PII], right?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Any other questions I can help out with today, [PII]?
[CUSTOMER][POSITIVE] Thank you so much, son.
[CUSTOMER][POSITIVE] No, this is the only claim I have. Thank you so much for your assistance. Have a great day.
[AGENT][POSITIVE] You're welcome thank you for calling APL have a good day.